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BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN 401k Plan overview

Plan NameBLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN
Plan identification number 501

BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Severance pay
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

BLUE CROSS & BLUE SHIELD OF MINNESOTA has sponsored the creation of one or more 401k plans.

Company Name:BLUE CROSS & BLUE SHIELD OF MINNESOTA
Employer identification number (EIN):410984460
NAIC Classification:524140

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01RUTH HAFOKA, SR VP CHIEF HR OFFICER
5012016-01-01RUTH HAFOKA
5012015-01-01DIANE POZDOLSKI, VP COMP. BEN. HRIS
5012014-01-01DIANE POZDOLSKI, VP COMP. BEN. HRIS
5012013-01-01DIANE POZDOLSKI, VP COMP. BEN. HRIS
5012012-01-01DIANE POZDOLSKI, VP COMP., BEN. & H
5012011-01-01DIANE POZDOLSKI, VP COMP., BEN. & H
5012009-01-01COLLEEN CONNORS, VP HUMAN RESOURCES
5012009-01-01COLLEEN CONNORS, VP HUMAN RESOURCES
5012008-11-01

Plan Statistics for BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN

401k plan membership statisitcs for BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN

Measure Date Value
2022: BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-014,629
Total number of active participants reported on line 7a of the Form 55002022-01-013,099
Number of retired or separated participants receiving benefits2022-01-011,207
Total of all active and inactive participants2022-01-014,306
Total participants2022-01-014,306
2021: BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-014,874
Total number of active participants reported on line 7a of the Form 55002021-01-013,330
Number of retired or separated participants receiving benefits2021-01-011,299
Total of all active and inactive participants2021-01-014,629
Total participants2021-01-014,629
2020: BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-013,850
Total number of active participants reported on line 7a of the Form 55002020-01-013,512
Number of retired or separated participants receiving benefits2020-01-011,362
Total of all active and inactive participants2020-01-014,874
Total participants2020-01-014,874
2019: BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-014,062
Total number of active participants reported on line 7a of the Form 55002019-01-013,600
Number of retired or separated participants receiving benefits2019-01-01250
Total of all active and inactive participants2019-01-013,850
Total participants2019-01-013,850
2018: BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-014,098
Total number of active participants reported on line 7a of the Form 55002018-01-013,817
Number of retired or separated participants receiving benefits2018-01-01245
Total of all active and inactive participants2018-01-014,062
Total participants2018-01-014,062
2017: BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-014,121
Total number of active participants reported on line 7a of the Form 55002017-01-013,823
Number of retired or separated participants receiving benefits2017-01-01275
Total of all active and inactive participants2017-01-014,098
Total participants2017-01-014,098
2016: BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-013,894
Total number of active participants reported on line 7a of the Form 55002016-01-013,898
Number of retired or separated participants receiving benefits2016-01-01223
Total of all active and inactive participants2016-01-014,121
Total participants2016-01-014,121
2015: BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-013,692
Total number of active participants reported on line 7a of the Form 55002015-01-013,719
Number of retired or separated participants receiving benefits2015-01-01175
Total of all active and inactive participants2015-01-013,894
Total participants2015-01-013,894
2014: BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-013,814
Total number of active participants reported on line 7a of the Form 55002014-01-013,477
Number of retired or separated participants receiving benefits2014-01-01215
Total of all active and inactive participants2014-01-013,692
Total participants2014-01-013,692
2013: BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-013,950
Total number of active participants reported on line 7a of the Form 55002013-01-013,536
Number of retired or separated participants receiving benefits2013-01-01278
Total of all active and inactive participants2013-01-013,814
Total participants2013-01-013,814
2012: BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-013,919
Total number of active participants reported on line 7a of the Form 55002012-01-013,660
Number of retired or separated participants receiving benefits2012-01-01290
Total of all active and inactive participants2012-01-013,950
Total participants2012-01-013,950
2011: BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-013,916
Total number of active participants reported on line 7a of the Form 55002011-01-013,582
Number of retired or separated participants receiving benefits2011-01-01337
Total of all active and inactive participants2011-01-013,919
Total participants2011-01-013,919
2009: BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-014,585
Total number of active participants reported on line 7a of the Form 55002009-01-013,679
Number of retired or separated participants receiving benefits2009-01-01495
Total of all active and inactive participants2009-01-014,174
Total participants2009-01-014,174

Form 5500 Responses for BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN

2022: BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes
2008: BLUE CROSS AND BLUE SHIELD OF MINNESOTA WELFARE BENEFIT PLAN 2008 form 5500 responses
2008-11-01Type of plan entitySingle employer plan
2008-11-01Submission has been amendedNo
2008-11-01This submission is the final filingNo
2008-11-01This return/report is a short plan year return/report (less than 12 months)No
2008-11-01Plan is a collectively bargained planNo

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0166155
Policy instance 3
Insurance contract or identification number0166155
Number of Individuals Covered40
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $10,843
Total amount of fees paid to insurance companyUSD $1,814
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedFLEX ADD
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,843
Additional information about fees paid to insurance brokerBASE COMMISSIONS
Insurance broker organization code?3
Amount paid for insurance broker fees1737
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number417688
Policy instance 2
Insurance contract or identification number417688
Number of Individuals Covered3052
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $112,770
Total amount of fees paid to insurance companyUSD $45,108
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedFLEX ADD
Welfare Benefit Premiums Paid to CarrierUSD $2,255,401
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $112,770
Amount paid for insurance broker fees45108
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number99077337
Policy instance 1
Insurance contract or identification number99077337
Number of Individuals Covered3099
Insurance policy start date2021-04-01
Insurance policy end date2022-04-01
Other welfare benefits providedACCIDENTAL DEATH
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number99077337
Policy instance 1
Insurance contract or identification number99077337
Number of Individuals Covered3330
Insurance policy start date2020-04-01
Insurance policy end date2021-04-01
Other welfare benefits providedACCIDENTAL DEATH
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number417688
Policy instance 2
Insurance contract or identification number417688
Number of Individuals Covered3510
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $131,842
Total amount of fees paid to insurance companyUSD $52,737
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedFLEX ADD
Welfare Benefit Premiums Paid to CarrierUSD $2,636,841
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $131,842
Amount paid for insurance broker fees52737
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0166155
Policy instance 3
Insurance contract or identification number0166155
Number of Individuals Covered33
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $10,576
Total amount of fees paid to insurance companyUSD $37
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedFLEX ADD
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,576
Insurance broker organization code?3
Amount paid for insurance broker fees37
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number417688
Policy instance 2
Insurance contract or identification number417688
Number of Individuals Covered3425
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $139,794
Total amount of fees paid to insurance companyUSD $55,918
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedFLEX ADD
Welfare Benefit Premiums Paid to CarrierUSD $2,791,268
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $139,794
Amount paid for insurance broker fees55918
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number99077337
Policy instance 1
Insurance contract or identification number99077337
Number of Individuals Covered3512
Insurance policy start date2019-04-01
Insurance policy end date2020-04-01
Other welfare benefits providedACCIDENTAL DEATH
Insurance broker organization code?3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number99077337
Policy instance 1
Insurance contract or identification number99077337
Number of Individuals Covered3600
Insurance policy start date2018-04-01
Insurance policy end date2019-04-01
Total amount of commissions paid to insurance brokerUSD $9,098
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $25,995
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,199
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number417688
Policy instance 2
Insurance contract or identification number417688
Number of Individuals Covered3702
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $152,256
Total amount of fees paid to insurance companyUSD $60,902
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedFLEX ADD
Welfare Benefit Premiums Paid to CarrierUSD $2,939,782
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $152,256
Amount paid for insurance broker fees60902
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number99077337
Policy instance 1
Insurance contract or identification number99077337
Number of Individuals Covered3817
Insurance policy start date2017-04-01
Insurance policy end date2018-04-01
Other welfare benefits providedACCIDENTAL DEATH
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number417688
Policy instance 2
Insurance contract or identification number417688
Number of Individuals Covered4487
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $133,790
Total amount of fees paid to insurance companyUSD $53,516
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedFLEX ADD
Welfare Benefit Premiums Paid to CarrierUSD $2,966,733
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $133,790
Amount paid for insurance broker fees53516
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract number99077337
Policy instance 2
Insurance contract or identification number99077337
Number of Individuals Covered3823
Insurance policy start date2016-04-01
Insurance policy end date2017-04-01
Other welfare benefits providedACCIDENTAL DEATH
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number417688
Policy instance 1
Insurance contract or identification number417688
Number of Individuals Covered4013
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $129,946
Total amount of fees paid to insurance companyUSD $51,978
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedFLEX ADD
Welfare Benefit Premiums Paid to CarrierUSD $2,417,891
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $129,946
Amount paid for insurance broker fees51978
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
Insurance broker nameHAYS BENEFITS GROUP LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL961424
Policy instance 1
Insurance contract or identification numberABL961424
Number of Individuals Covered3555
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $1,487
Total amount of fees paid to insurance companyUSD $205
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $9,910
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,487
Amount paid for insurance broker fees205
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameHAYS COMPANIES
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number417688
Policy instance 2
Insurance contract or identification number417688
Number of Individuals Covered3728
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $103,683
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $2,073,659
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $103,683
Insurance broker organization code?3
Insurance broker nameHAYS BENEFITS GROUP LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL961424
Policy instance 1
Insurance contract or identification numberABL961424
Number of Individuals Covered3498
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $1,501
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $10,005
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,501
Insurance broker organization code?3
Insurance broker nameHAYS COMPANIES
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number677557-0GL
Policy instance 2
Insurance contract or identification number677557-0GL
Number of Individuals Covered3598
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $11,603
Total amount of fees paid to insurance companyUSD $5,681
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $232,071
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,603
Insurance broker organization code?3
Amount paid for insurance broker fees5681
Additional information about fees paid to insurance brokerBONUS
Insurance broker nameHAYS BENEFITS GROUP INC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number677557-GLT
Policy instance 3
Insurance contract or identification number677557-GLT
Number of Individuals Covered3473
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $25,247
Total amount of fees paid to insurance companyUSD $15,333
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $546,669
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,247
Insurance broker organization code?3
Amount paid for insurance broker fees15333
Additional information about fees paid to insurance brokerBONUS
Insurance broker nameHAYS BENEFITS GROUP INC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number677557-0GL
Policy instance 2
Insurance contract or identification number677557-0GL
Number of Individuals Covered3509
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $12,473
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $286,809
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,473
Insurance broker organization code?3
Insurance broker nameHAYS GROUP INC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number677557-GLT
Policy instance 3
Insurance contract or identification number677557-GLT
Number of Individuals Covered3565
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $25,782
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $535,187
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,782
Insurance broker organization code?3
Insurance broker nameHAYES GROUP LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL961424
Policy instance 1
Insurance contract or identification numberABL961424
Number of Individuals Covered3543
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $1,661
Total amount of fees paid to insurance companyUSD $178
Other welfare benefits providedACCIDENTAL DEATH
Welfare Benefit Premiums Paid to CarrierUSD $11,070
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,661
Amount paid for insurance broker fees178
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameHAYS COMPANIES
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL961424
Policy instance 1
Insurance contract or identification numberABL961424
Number of Individuals Covered3524
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $1,534
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $10,225
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,534
Insurance broker organization code?3
Insurance broker nameHAYS COMPANIES
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number093872
Policy instance 5
Insurance contract or identification number093872
Number of Individuals Covered227
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $18,806
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $156,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SELECTHEALTH (National Association of Insurance Commissioners NAIC id number: 95153 )
Policy contract numberG1007129 1001
Policy instance 3
Insurance contract or identification numberG1007129 1001
Number of Individuals Covered377
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,180,135
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number677557-0GL
Policy instance 2
Insurance contract or identification number677557-0GL
Number of Individuals Covered3642
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $11,354
Total amount of fees paid to insurance companyUSD $12,939
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $168,535
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees12939
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $11,354
Insurance broker nameHAYS GROUP INC
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number677557-GLT
Policy instance 3
Insurance contract or identification number677557-GLT
Number of Individuals Covered3663
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $28,181
Total amount of fees paid to insurance companyUSD $17,122
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $502,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,092
Amount paid for insurance broker fees17122
Additional information about fees paid to insurance brokerBONUS PAID
Insurance broker organization code?3
Insurance broker nameHAYES GROUP INC
BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 )
Policy contract numberGP560
Policy instance 2
Insurance contract or identification numberGP560
Number of Individuals Covered226
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $1,691
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,303,623
DELTA DENTAL PLAN OF ARKANSAS (National Association of Insurance Commissioners NAIC id number: 81396 )
Policy contract number06277
Policy instance 1
Insurance contract or identification number06277
Number of Individuals Covered576
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $213,160
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SELECTHEALTH (National Association of Insurance Commissioners NAIC id number: 95153 )
Policy contract numberG1007129 T001
Policy instance 4
Insurance contract or identification numberG1007129 T001
Number of Individuals Covered39
Insurance policy start date2013-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $190,060
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL961424
Policy instance 1
Insurance contract or identification numberABL961424
Number of Individuals Covered3483
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $1,560
Total amount of fees paid to insurance companyUSD $76
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $10,225
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number101317201
Policy instance 3
Insurance contract or identification number101317201
Number of Individuals Covered3480
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $13,362
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $256,811
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number677557G
Policy instance 2
Insurance contract or identification number677557G
Number of Individuals Covered3544
Insurance policy start date2010-11-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $25,687
Total amount of fees paid to insurance companyUSD $13,227
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $513,786
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberABL961424
Policy instance 1
Insurance contract or identification numberABL961424
Number of Individuals Covered3521
Insurance policy start date2009-04-01
Insurance policy end date2010-03-31
Total amount of commissions paid to insurance brokerUSD $1,534
Total amount of fees paid to insurance companyUSD $52
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $10,225
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,534
Amount paid for insurance broker fees52
Additional information about fees paid to insurance brokerSUPP. COMMISSION
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE SERVICES
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number677557G
Policy instance 2
Insurance contract or identification number677557G
Number of Individuals Covered3587
Insurance policy start date2009-11-01
Insurance policy end date2010-10-31
Total amount of commissions paid to insurance brokerUSD $26,261
Total amount of fees paid to insurance companyUSD $11,491
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $525,211
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,261
Amount paid for insurance broker fees11491
Additional information about fees paid to insurance brokerBONUSES PAID
Insurance broker nameHAYS BENEFITS GROUP LLC
USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )
Policy contract number3172-01
Policy instance 3
Insurance contract or identification number3172-01
Number of Individuals Covered3545
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $13,111
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $262,218
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,111
Insurance broker organization code?3
Insurance broker nameTHOMAS SEIFERT

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